Encephalitis: Treatment and Prevention

Encephalitis is the inflammation of the brain, which is often caused by a virus or bacteria. Encephalitis can also be a feature of disease conditions.

Encephalitis can cause flu-like symptoms and severe headache. Because it affects the brain, you may experience confusion, altered thinking, problems in senses and movement, and seizures.

Encephalitis can be mild, barely causing symptoms, or so severe that it causes life-threatening complications.

Since there is no way to predict the outcome of encephalitis, it requires prompt diagnosis and treatment.

Encephalitis can be so mild that you might only experience the following symptoms:

• Fever
• Headache
• Muscle and joint discomfort
• Fatigue or unexplained weakness

Severe encephalitis may cause serious symptoms.

Aside from the symptoms mentioned above, you might experience the following:

• Seizures
• Fainting
• Speech and hearing problems
• Loss of sensation in your face of body
• Muscle weakness or paralysis, or the inability to move a limb or part of the face
• Confusion
• Agitation or hallucinations
• Double vision or vision changes
• Unusual perception of foul smells, like burning meat or rotten eggs, even if those things are not present

In children and babies, encephalitis may cause the following symptoms:

• Bulging fontanels (soft spots on infant’s skull)
• Stiffness of the body
• Nausea and vomiting
• Irritability, and almost non-stop crying
• Marked lethargy or sleepiness that may cause poor feeding

If you have or find these serious symptoms of encephalitis to your child, call emergency hotlines and go to the hospital immediately. A severe headache with fever and fainting, regardless of cause, requires urgent care.

Viruses or bacteria cause most cases of encephalitis. In the majority of cases, however, the exact cause of encephalitis is often undetermined.

There are two ways bacteria or viruses cause encephalitis:

• Primary encephalitis is the direct infection of the brain. It can cause either localized or widespread infection. Some cases of primary encephalitis are caused by reactivation of dormant viruses caused by previous illnesses.
• Secondary or postinfectious encephalitis happens when bacteria or viruses provoke immune system reaction, which kills them but also attacks healthy cells in the brain by mistake. Secondary encephalitis tends to occur one to three weeks after initial infection. Vaccination with live viruses can cause secondary encephalitis, but this is very rare.

Viral causes of encephalitis

Many of these viruses also cause diseases.

Here are the common viruses that cause encephalitis:

• Herpes simplex viruses (HSV-1 and HSV-2) – HSV-1 causes cold sores while HSV-2 causes genital herpes.
• Other herpes viruses – like Epstein-Barr virus (causes mononucleosis) and varicella-zoster virus (causes chicken pox and shingles).
• Enteroviruses – such as Coxsackievirus virus and the virus that cause polio
• Mosquito-borne viruses – mosquitoes are important vectors of several disease-causing viruses that may cause encephalitis. These viruses include West Nile, La Crosse, St. Louis, Western Equine and Eastern Equine. Mosquitoes often transmit encephalitis-causing viruses from animal reservoirs (like horses, deer or chipmunk) to humans.
• Tick-borne viruses – like Powassan virus are transmitted through tick bites. Viruses caused by tick bites tend to cause symptoms in about a week.
• Rabies viruses – cause serious encephalitis at its later stages that result to death. Rabies is rare in the United States. Patients with animal bites can be treated with rabies immunoglobulin to prevent rabies infection.
• Measles, mumps, and German measles – are once common childhood viral infections that often cause encephalitis. Thanks to widespread vaccinations, these infections are now rare.

For suspected encephalitis, you will be referred to a specialist for brain disorders called the neurologist to receive a diagnosis.

Symptoms of encephalitis are severe and often progresses quickly, so it is likely for you to end up in the emergency department.

Expect to answer questions when receiving care. Your doctor may ask you to detail the following:

• Description of symptoms and times of onset.
• Recently taken medications
• History of mosquito or tick bites, or staying in places near habitats of mosquitoes and ticks.
• Having illnesses like colds, flu and others.
• Whether you have unprotected sex.
• Vaccination status, shots received during childhood and booster shots.
• Exposure to animal bites and toxins.
• Having medical problems or taking drugs that depress the activity of immune system.

Encephalitis can be treated by several methods.

Encephalitis may be easily mistaken for flu. The good thing is that treatments for flu tend to work well for mild cases of encephalitis, like bed rest, plenty of fluids and taking anti-inflammatory medications like acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) to relieve headaches and fever.

Viral hepatitis treatment

For encephalitis caused by viruses, the doctor may prescribe antiviral drugs like acyclovir (Zovirax), Ganciclovir (Cytovene) and foscarnet (Foscavir). These drugs may be administered through your vein for faster onset of effect. Antiviral drugs are often given for suspected cases of viral hepatitis whose cause is not yet fully identified to prevent serious complications and death.
Side effects of antiviral drugs include nausea and vomiting, diarrhea and pain in joints and muscles. In rare cases, antivirals may cause problems in liver and kidneys, or suppress the activity of the bone marrow. Your doctor will order regular lab tests to monitor the health of your liver and kidneys during treatment.

Supportive care

Patients with severe encephalitis need supportive care. You may be hooked to machines that carefully monitors your breathing and heart rate. Intravenous fluids make sure you remain hydrated and allow administration of drugs injected into the vein.

You may be given the following drugs:

• Corticosteroids are potent anti-inflammatory drugs that reduce swelling and pressure inside your skull.
• In case you are susceptible or already experienced seizures, you may be given anticonvulsant medications like phenytoin (Dilantin).

Follow-up therapy

Encephalitis affects the brain, and in severe cases can result to problems in movement, personality and senses.

After treatment, the doctor may prescribe you to have the following therapies:

• Physical therapy helps improve strength, flexibility, balance and fine motor skills that could have been affected by encephalitis.
• Psychotherapy is used to deal with mood disorders and personality changes
• Speech therapy
• Occupational therapy

Simple measures can prevent you or your child from having encephalitis:

• Wash your hands regularly, especially after using the bathroom and before eating.
• Teach good hygiene practices to your children
• Avoid sharing utensils and beverages
• Make sure you and your child are completely vaccinated

Ticks and mosquitoes can give you encephalitis, and it only takes one bite to do so.

However, you can avoid bites by doing the following:

• Use mosquito repellent – approved repellents include DEET, IR3535, Picaridin and lemon eucalyptus (not for children below 3 years of age). For complete protection, apply mosquito repellents on skin and clothes. You can apply it on the face by spraying into the hands and then wiped on the face.
• Wearing long-sleeved shirts and long pants helps protect against mosquitoes and ticks. Do wear these clothing items when venturing into wooded or shrubby areas.
• Avoid going to places where mosquitoes are prevalent, especially on times between dusk until dawn. Keep them out of the house using screens on doors and windows.
• Hunt for places where mosquitoes breed and rest. Search and remove stagnant water around the house. Pay attention to water in flowerpots, gardening containers, roofs, old tires and clogged gutters.
• You can prevent mosquitoes laying eggs in ponds, water storage areas, ornamental pools, and birdbaths. Use mosquito dunks, which poison mosquito larvae, or fill pools with fish that eats mosquito larvae.
• Apply insecticides on clothing, tents, and outdoor gear, and only use EPA-approved insecticide.
• Viruses that cause encephalitis tends to harbor in animals. Look out for signs of viral diseases in animals. If you saw sick or dying animals or birds, call your local health department.

Protecting young children

Insect repellents are often not recommended for young children and babies. When going out, cover the infant carrier or stroller with mosquito netting.

For older children, do the following measures to protect them against mosquitoes and ticks:

• Teach and assist older children in the proper use of mosquito repellent.
• Apply repellent outdoors to reduce possibilities of inhalation.
• To apply on the face, spray the repellent on hands and apply it to the face, carefully avoiding the eyes and ears.

Here are the factors that increase risk for encephalitis:

• Certain age groups, like young children and older adults, are at risk for viruses that cause encephalitis. Individuals ages 20’s to 40’s engaging in risky sexual behaviors are at risk for herpes simplex virus infections.
• Ticks and mosquitoes tend to breed more at certain times of the year, like during spring, summer, and early fall. Warmer regions tend to have mosquitoes and ticks all year round.
• Weakened immune systems, which can be caused by having HIV, taking drugs that suppress the immune system (like steroids), or having chronic illnesses.